A profound health-care crisis has struck. But nobody's listening.

The Disappearance of Florence Nightingale

Woody Hanes recently received a memo that underscored the dilemma facing the nursing profession.

"It seems obvious that both state and local study and planning are necessary if the health needs of Virginia are to be met," it began.

Hanes chuckled. The memo was dated 1966.

The memo, from an annual nursing report, is a reminder of what Hanes, program director for the Virginia Area Health Education Centers, knows all too well: A shortage of trained nurses is nothing new.

But today's nursing shortage, say Hanes and her colleague JoAnne Kirk Henry, co-chair of the Virginia Partnership for Nursing (VPN) and director of the Office of Health Care Policy at Virginia Commonwealth University, is as terrible as it is familiar.

As the memo points out, the health-care industry has had 35 years to resolve its problems of recruiting and retaining nurses, and expanding their educational opportunities. But proof is mounting that the problem is still here.

And it's getting worse. All aspects of hospitals are being affected. Patients are being turned away from understaffed hospital emergency rooms and sent to other divisions or other hospitals. With fewer nurses to staff the hospitals, even run-of-the-mill admissions take longer. Meanwhile, nurses are working double shifts and extra days.

So exigent is the competition for nurses that recruiters for VCU's Medical College of Virginia Hospitals took a trip to the Middle East to recruit nurses  and still won't talk about it because hospital officials worry that competitors will rush in to steal the nurses.

All this does not add up to quality health care.

But despite alarming reports of understaffing  one nursing home in the area recently reported a 47 percent vacancy rate for nurses  few, other than nurses, have listened.

It's true that shortages in nursing are cyclical; they reoccur about every eight to 10 years. But this one, nurses contend, is remarkably difficult.

A recent study by the Journal of the American Medical Association predicts that exploding demand for registered nurses to care for America's graying population of baby boomers could outstrip supply by 2010. The Bureau of Labor Statistics projects nursing will have the most new jobs by 2008  even as the number of students in nursing-education programs is declining. Meanwhile, many nurses are nearing retirement. The national median age for RNs is 45.

It all comes down to this: Will a nurse be there when you need one? "We have on the horizon, and right now, a serious problem that we've been patching," says Rebecca Rice, deputy director for Colleagues in Caring, a national grant program that addresses workforce issues.

The Virginia Partnership for Nursing was created in late 1999 to provide a more durable kind of relief. The organization already is running to catch up with the crisis. "It just makes you irritated you didn't see it coming fast enough to get out in front," the partnership's Henry explains.

The partnership first intends to figure out exactly how big the problem is. Although there are national statistics, little is known about the nursing supply in Virginia. And some of what is known is confusing.

For example, preliminary findings from a March 2000 study by the U.S. Department of Health and Human Services finds that of 66,466 registered nurses in Virginia, 50,359 currently hold jobs in nursing  meaning that 16,107 registered nurses have left the field.

With 24 percent of its licensed nurses not employed as nurses, Virginia ranks third  behind Pennsylvania and Arizona  among the states. So why do these nurses have  and renew  their licenses if they aren't working in healthcare?

Figuring out such questions, the partnership says, should be the responsibility of the state. Considering the governor's current budget crisis, however, the state isn't eager to take on extra expenses.

Still, together with the Legislative Coalition for Virginia Nurses, the partnership hopes to put new programs in place. Among them: easy access to educational opportunities, the creation of the Virginia Workforce Center to address supply and demand issues, and efforts to increase cultural, racial and ethnic diversity in the nursing profession.

The group will meet to discuss these and other initiatives March 23 at the Nursing Leadership Summit on Strategic Planning at the Sheraton West in Richmond.

Two bills did pass in this year's General Assembly that begin to address problems hospitals, nursing homes and other employers are having recruiting and retaining nurses.

House Joint Resolution 664, a recommendation of the Joint Commission on Health Care, asks the partnership to examine nurse-education programs. The group has been given $40,000 in "budget dust" to collect data, says Leslie Herdegen, general counsel and lobbyist for the legislative coalition.

And Senate Bill 1378 was introduced to create the Advisory Council on the Future of Nursing in Virginia. The council would study the current situation and future needs for nurses and make recommendations to policymakers. What's more, says Henry, the bill for the first time brings together the state secretary of health and human services and the secretary of education to address the nursing problem. Gov. Jim Gilmore has until midnight on March 26 to sign the measure.

Some in the nursing partnership worry that the bill will languish unsigned. "We get the impression that the administration is not wildly excited about it," says Herdegen. "Can we delay? Of course. But [that] will set us back a year."

The good news is nurses are finally starting to speak out about their situation. Working nurses are in strong demand, and some are earning more than ever. Nonetheless, "no nurse wants there to be a nursing shortage," says Henry. As the director of Virginia Area Health Education Centers, Hanes says she's willing to recruit 10th-graders at career fairs. "When we look at recruitment strategies, we've got to look at what makes nursing attractive," she says.

Still, not everyone is cut out to be a nurse. It takes a rugged heart and immediate hands. It demands initiative and skill.

And it means debunking the idea that a nurse's role is subordinate in health care.

"My hunch is if we were talking about a doctor shortage people would be more attentive to it," says Herdegen. "But a nursing shortage means no health care for some